in partial gastrectomy , why can’t we do bilroth 1 ?
In partial gastrectomy, the surgical removal of a portion of the stomach is performed due to various medical conditions, such as peptic ulcers or tumors. Bilroth I and Bilroth II are two types of gastrectomy procedures named after the surgeon who developed them, Theodor Billroth.
Bilroth I (Gastroduodenostomy):
- In Bilroth I procedure, the remaining portion of the stomach is anastomosed (connected) to the duodenum.
- This type of reconstruction is technically challenging and is not always feasible, especially if there is limited mobility or tension in the duodenum.
Bilroth II (Gastrojejunostomy):
- In Bilroth II procedure, the remaining portion of the stomach is anastomosed to the jejunum.
- This is a more commonly performed procedure as compared to Bilroth I.
The choice between Bilroth I and Bilroth II depends on several factors, including the underlying pathology, the location and extent of the disease, and the surgeon’s expertise. In some cases, Bilroth I may not be feasible or may carry a higher risk of complications. Some reasons why Bilroth I might not be performed include:
- Limited Duodenal Mobility:
- If there is limited mobility or tension in the duodenum due to scarring, inflammation, or other factors, creating a successful anastomosis between the stomach and duodenum may be challenging.
- Inadequate Blood Supply:
- Adequate blood supply to the duodenum is crucial for the healing of the anastomosis. If blood supply is compromised, especially in the proximal duodenum, Bilroth I may not be a suitable option.
- Tumor Involvement:
- If the pathology involves the duodenum extensively or if there is tumor involvement near the duodenal stump, Bilroth I might not be the preferred choice.
- Technical Challenges:
- Bilroth I is considered a more technically demanding procedure, and surgeons may opt for Bilroth II if they anticipate challenges in performing a successful Bilroth I anastomosis.
In summary, while Bilroth I is a valid and effective reconstruction option in certain cases, it may not be chosen in partial gastrectomy due to technical challenges, inadequate blood supply, or the involvement of the duodenum in the disease process. The decision between Bilroth I and Bilroth II is made based on individual patient factors and the surgeon’s judgment.